Rotator cuff injuries are a common cause of shoulder pain. Although a rotator cuff injury is frequent among athletes, such an injury can also occur due to trauma and the “wear and tear” of the tendons over time. Rotator cuff injuries can lead to significant shoulder weakness, and treatment is necessary to correct this problem.
Anatomy of the Shoulder
The shoulder is a “ball and socket” joint, with the ball-shaped head of the upper arm bone (humerus) fitting into a socket called the glenoid. A rotator cuff is a group of four muscles and tendons that helps with lifting and rotating the arm. It also helps to stabilize the shoulder and facilitate shoulder movement.
Classification of Rotator Cuff Tears
Rotator cuff tears can be classified as follows:
- Partial Tear. One or more tendons in the rotator cuff are damaged, but not completely severed.
- Complete Tear. One or more tendons in the rotator cuff are completely severed from the humerus (upper arm bone).
- Acute Tear. The tear is caused by injury/trauma, such as a fall or lifting something that is too heavy.
- Degenerative Tear. The tear occurs gradually and naturally as we age.
Over time, the rotator cuff is susceptible to degenerative changes. Bone spurs can develop on the underside of the acromion, a bone that forms the roof of the shoulder. As we age, the blood supply to the rotator cuff can decrease, making it more difficult for the body to repair tendon damage naturally. This “wear and tear” on the rotator cuff can increase the likelihood of a rotator cuff tear or another injury.
What causes a rotator cuff tear?
A rotator cuff tear can occur suddenly. It may happen by falling onto an outstretched arm or lifting something heavy.
A rotator cuff tear can also develop slowly over time. Repetitive shoulder motions during sports and physical activity are often contributing factors. A rotator cuff tear is common among athletes in sports like baseball, tennis, and weightlifting.
Additionally, degenerative changes to the shoulder may increase the likelihood of a rotator cuff tear. In this instance, bone spurs that develop on the underside of the acromion rub against the rotator cuff.
What are the symptoms of a rotator cuff tear?
Symptoms of a rotator cuff tear include shoulder pain and a crackling sensation when moving the shoulder. You may feel pain even while the shoulder is at rest, as well as pain and weakness when lifting and lowering the arm. Most people experience pain at night and have trouble sleeping, especially when lying on the affected shoulder. If the tear is sudden, you may hear a snapping sound and have immediate weakness in the upper arm.
If you are experiencing any of these symptoms, you should seek medical treatment.
What treatment is available for a rotator cuff tear?
A rotator cuff injury can cause significant shoulder weakness. Proper treatment can help patients regain shoulder strength and function after an injury.
At Go to Ortho, we offer both nonsurgical and surgical treatment options for a rotator cuff injury.
Nonsurgical Treatment Options for a Rotator Cuff Injury
In many cases, nonsurgical options are initially recommended to treat a rotator cuff injury, unless the patient experiences significant shoulder weakness and has difficulty raising the arm. While a full-thickness rotator cuff tear will not heal without surgery, patients with a partial tear may have positive results with nonsurgical treatment.
Nonsurgical treatment involves a combination of rest, activity modification, medications, physical therapy, and cortisone injections.
While nonsurgical treatment is effective in relieving pain for many patients, there is a possibility that the tear may get larger without surgical repair. Patients may need to modify their activities to reduce that risk. For this reason, athletes often move forward with the surgical repair so that they are able to return to sports after recovering from the surgery.
Surgical Treatment Options for a Rotator Cuff Injury
Surgery may be recommended if nonsurgical treatment does not relieve symptoms, or in the event of a large tear in the shoulder.
Rotator cuff surgery is typically done arthroscopically in the vast majority of cases, but open surgery may be necessary for large or complex tears.
Arthroscopy involves using a camera attached to a cube-like lens to view the structures of the shoulder and reattach the torn rotator cuff. The arthroscope is inserted into the shoulder through small incisions and displays images of the internal shoulder structure on a monitor. This allows the orthopedic surgeon to repair the rotator cuff using much smaller incisions (about 3/8 of an inch) than would be required with open surgery. This approach often results in quicker recovery times and less pain after surgery.
On rare occasions, the rotator cuff tear is so large that it is irreparable. In these cases, a superior capsular reconstruction with a dermal graft may be needed. If the patient also has severe arthritis in the shoulder with a massive rotator cuff tear, a reverse total shoulder replacement may be necessary.
What is recovery like after rotator cuff surgery?
Patients who undergo rotator cuff surgery typically experience less pain during recovery. The arm will likely need to be in a sling for 4-6 weeks while the tendon heals.
Complete recovery from rotator cuff surgery takes approximately 4-6 months. The majority of patients have greater shoulder strength and less pain in recovery.
Physical therapy and strengthening exercises are an important part of recovery. Rehab begins with passive motion exercises. After approximately 4-6 weeks, patients progress to active motion exercises and gradually build up to strengthening exercises.
Rotator Cuff Treatment in Lake Oswego and the Portland Metro Area
At Go To Ortho, our staff is here to assist you every step of the way to make sure rotator cuff treatment is as easy on you as possible. If you have any questions about rotator cuff treatment or would like to schedule an appointment, please call our office at 503.850.9950.
Come see us for any rotator cuff injuries. Walk-in appointments are welcome. View our hours.
